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Patient Instructions

You were in the hospital to have your heart failure treated. Heart failure occurs when the muscles of your heart are weak. Your heart is a pump that moves fluids through your body. As with any pump, if the flow is not strong enough, fluids do not move well and they get stuck in places they should not be. In your body, this means that fluid collects in your lungs and legs.

While you were in the hospital:

• Your health care team closely adjusted the fluids you drank or received through an intravenous line (IV). They also watched and measured how much urine you produced.
• You may have received medicines to help your body get rid of extra fluids.
• You may have had tests to check how well your heart was working.

Your energy will slowly return. You may need help taking care of yourself when you first get home. You may feel sad or depressed. All of these things are normal.

Weigh yourself every morning on the same scale when you get up -- before you eat and after you use the bathroom. Make sure you are wearing similar clothing each time you weigh yourself. Write down your weight every day on a chart so that you can keep track of it. See also: Heart failure - home monitoring

Throughout the day, ask yourself:

• Is my energy level normal?
• Do I get more short of breath when I am doing my everyday activities?
• Are my clothes or shoes feeling tight?
• Are my ankles or legs swelling?
• Am I coughing more often? Does my cough sound wet?
• Do I get short of breath at night?

If you are having new (or different) symptoms, ask yourself:

• Did I eat something different than usual or try a new food?
• Did I take all of my medicines the right way at the right times?

Your doctor may ask you to limit how much you drink. See also: Heart failure - fluids and diuretics

• When your heart failure is not very severe, you may not have to limit your fluids too much.
• As your heart failure gets worse, you may be asked to limit fluids to 6 to 9 cups a day (about 1 1/2 to 2 liters).

You will need to eat less salt. Salt can make you thirsty, and being thirsty can cause you to drink too much fluid. Extra salt also makes fluid stay in your body. See also: Low-salt diet

Your doctor may ask you to take a diuretic, or water pill.

Do not drink alcohol. Alcohol makes it harder for your heart muscles to work. Ask your doctor or nurse what to do on special occasions where alcohol and foods you are trying to avoid will be served.

If you smoke, stop. Ask your doctor for help quitting if you need it. Do not let anybody smoke in your home.

Learn more about what you should eat to make your heart and blood vessels healthier.

• Avoid fatty foods.
• Stay away from fast-food restaurants.

See also: Fast food tips

Try to stay away from things that are stressful for you. If you feel stressed all the time, or if you are very sad, talk with your doctor or nurse. They can refer you to a counselor.

Have all of your drug prescriptions filled before you go home. It is very important that you take your drugs the way your doctor and nurse told you to. Do not take any other drugs or herbs without asking your doctor or nurse about them first.

Take your drugs with water. Do not take them with grapefruit juice, since it may change how your body absorbs certain medicines. Ask your doctor or pharmacist if this will be a problem for you.

The drugs below are given to most people who have heart failure. Sometimes there is a reason they may not be safe to take, though. These drugs help protect your heart. Talk with your doctor or nurse if you are not already on any of these drugs:

• Antiplatelet drugs (blood thinners) such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin) to help keep your blood from clotting
• Beta blocker and ACE inhibitor medicines to lower your blood pressure
• Statins or other drugs to lower your cholesterol

See also:

• ACE inhibitors
• Aspirin and heart disease
• Cholesterol - drug treatment
• Clopidogrel (Plavix)

Never just stop taking these drugs for your heart, or any other drugs you may be taking for diabetes, high blood pressure, or any other medical conditions you may have.

If you are taking a blood thinner, such as warfarin (Coumadin), you will need to have extra blood tests to make sure your dose is correct.

Your doctor may refer you to cardiac rehabilitation program. There, you will learn how to slowly increase your exercise and how to take care of your heart disease. Make sure you avoid heavy lifting.

See also: Being active when you have heart disease

Make sure you know the warning signs of heart failure and of a heart attack. Know what to do when you have chest pain. See also: Angina - when you have chest pain

Always ask your doctor before starting sexual activity again. Do not take sildenafil (Viagra), or vardenafil (Levitra), tadalafil (Cialis), or any herbal remedy for erection problems without checking with your doctor first.

Make sure your home is set up to be safe and easy for you for you to move around in.

See also: Preventing falls

If you are unable to walk around very much, ask your doctor or nurse for exercises you can do while you are sitting.

Make sure you get a flu shot every year. You may also need a pneumonia shot. Ask your doctor about this.

Your doctor or nurse may call you to see how you are doing and to make sure you are checking your weight and taking your medicines. You will need follow-up appointments at your doctor's office.

Call your doctor if:

• You gain more than 2 pounds in a day, or 5 pounds in a week.
• You are very tired and weak.
• You are dizzy and lightheaded.
• You are more short of breath when you are doing your normal activities.
• You have new shortness of breath when you are sitting.
• You need to sit up or use more pillows at night because you are short of breath when you are lying down.
• You are wheezing and having trouble breathing.
• You feel pain or pressure in your chest.
• You have a cough that does not go away. It may be dry and hacking, or it may sound wet and bring up pink, foamy spit.
• Your have swelling in your feet, ankles or legs.
• You have to urinate a lot, especially at night.
• You have stomach pain and tenderness.
• You have symptoms that you think may be from your medicines.
• Your pulse, or heartbeat, gets very slow or very fast, or it is not steady.

Congestive heart failure - discharge; CHF - discharge; HF - discharge

Hess OM and Carroll JD. Clinical assessment of heart failure. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Libby: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders; 2007: chap 23.

Hunt SA; American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2005 Sep 20;46(6):e1-82

Updated by: Larry A. Weinrauch MD, Assistant Professor of Medicine, Harvard Medical School, Cardiovascular Disease and Clinical Outcomes Research, Watertown, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.